ABSTRACT Dementia and the opioid epidemic are two escalating public health challenges in the US. Over half of those with dementia regularly experience pain. Despite improvement in pain recognition and treatment among older adults, dementia patients are less likely than those without dementia to receive appropriate pain medication. Opioid use has quadrupled in the last decade, with over one third of nursing home residents prescribed opioids. Prior studies have shown variations in medication use (for antipsychotics, antidepressants, antibiotics and statins) across nursing homes. It is unknown how opioids are used for pain management in nursing home residents with dementia and if such use varies across nursing homes. To address this research gap, we propose to conduct a nationally representative study to examine the use of opioids in nursing home residents with dementia. Our specific aims are: 1. Describe the prevalence, duration, and dose of opioid use among long-term care nursing home residents with dementia, related to their pain level. 2. Compare the rate of opioid use among long-term care nursing home residents with dementia to that of residents without dementia. 3. Determine the variation in opioid use across nursing homes among long-term care residents with dementia and identify the patient, prescriber and facility level characteristics associated with this variation. We will use the Minimum Data Set and Medicare claims data from 2008 to 2016 for this study. This research will provide policy-relevant and clinically useful information to ensure the safe and effective use of opioids in nursing home residents with dementia.